HH/NURS 3524 6.

0:
Health & Healing: Client Centered Care of Individuals and Families in Child and Mental Health
Settings

Course Director (Mental Health)

Ann Pottinger RN,MN

Assistant Professor, Teaching Stream

pann@yorku.ca

How are we doing? Learning Together Guidelines – Agreements

❑ Positive interdependence: The group is connected by a common goal. For the group to
succeed, all individuals must succeed.

❑ Individual accountability: Each of us is accountable for what we learn and for facilitating
the learning of our classmates. Being on time for class, being prepared, informing your
group of absences prior to class time, and supporting classmates.

❑ Face-to-face interactions: Dialogue with each other promotes continued progress.

❑ Social skills for groups to function effectively: Listening, respecting the perspectives of
others, encouraging and supporting, taking turns and giving help, and clarifying and
checking for understanding.

Guidelines for Class and Group Experiences

(Adapted from Bennett, B., Rolheiser-Bennett, C. & Stevahn, L. (1991). Cooperative learning:
Where heart meets the mind)

Additionally, each student will:

❑ Contribute to a respectful, welcoming, safe and inclusive learning environment that

honours the knowledge and experiences of our diverse group of learners.

Looking Back … Objectives for Week 2

Students will:

❑ Examine the legal implications of the Ontario Mental Health Act on patient care, patient safety
and mitigating risk Part 1

❑ Analyze the importance of assessment and apply the concepts in conducting a mental status
examination Part 2

❑ Discuss mood disorder – focus depression Part 2

 ❑ Analyze the implications of nursing practice caring for patient experiencing depression Part 2

❑ Recognize suicide and self injury as key patient safety issue Part 3

Week by Week Roadmap

Test # 1 –30% Jan. 31 8:45 a.m.

Focus of the test is on knowledge and application of the following:

▪ Therapeutic Relationships and Communication – Relationship stages and

boundaries

▪ Mental Health, mental Illness, mental health nursing, stigma, recovery,

resilience

▪ Culturally safe, culturally competent care

▪ Assessment Process - Mental Status Assessment

▪ Mental Health Act – consent, involuntary, voluntary capable

▪ Depression, mania, suicide, self harm, dementia (features), delirium other

neurocognitive disorders

▪ Anxiety (including panic attack, OCD) PTSD, Eating Disorder, ADD, ADHD, Autism

▪ Nursing role – assessments, interventions, standards and competencies r/ t

topics/content listed – this includes non-pharmacological (e.g.) CBT,
psychoeducation, therapeutic relationship and pharmacological (e.g. SSRIs,
MAOI, Lithium) – medication calculation (calculator permitted)

✓ All class/practicum/ and assigned readings content up to and including Week 3

✓ 40 questions mostly multiple-choice questions (including some select all that apply max.), short
answer, matching, fill in the blank

✓ 1 hour

Objectives

At the end of this lecture students will:

❑ Identify symptoms of depression and pharmacological treatments (Week 2 cont’d)

❑ Discuss issues and treatment options

▪ Bipolar Affective Disorder - mania

▪ Anxiety Disorders PART 1

▪ Dementia
 ❑ Discuss nursing care to individuals with anorexia nervosa, bulimia nervosa, and binge
eating disorders

❑ Discuss options for children’ mental health issues

▪ Common childhood stressors and neurocognitive disorders

❑ Distinguish the clinical features, onset and course of neurocognitive disorders – delirium
and dementia

❑ Readings

Week 3 Required Readings:

Austin, Kunyk, Peternelj-Taylor & Boyd

Chapters: 22, 23, 30,32 Beginning up to and including Box 32.7

Box 25.1 Physiological Characteristics Related to Eating Disorders

Table 25.2 Complications of Eating Disorders

Table 25.4 Cognitive Distortions…

Box 25.10 What family and friends can do..

Mnemonic for Assessing Possible Depression

Antidepressant Classes

SSRI

SNRI

MAOI

TCA

Wellbutrin

SSRIs:

Decrease serotonin blockers in the brain

sertraline (Zoloft)

fluoxetine (Prozac)

citalopram (Celexa)

escitalopram (Lexapro)

paroxetine (Paxil, Pexeva)

 fluvoxamine (Luvox)

trazadone (Oleptro)

SE: fatigue, diarrhea, stomach upset, nausea, dry mouth, rash, weight loss/gain, insomnia, headaches,
low sex drive; hyponatremia

Serotonin syndrome: confusion, sweating, diarrhea, agitation, fever, arrhythmia, seizures, LOC

SNRI

SNRI: improve serotonin and norepinephrine levels

desvenlafaxine (Pristiq)

duloxetine (Cymbalta)

venlafaxine (Effexor XR)

SE: elevated BP, loss of weight, appetite, nausea, vomiting, urinary retention, sexual
dysfunction, increase in SI

Contraindication: hypertension and CAD

TCA

TCA: used when SSRIs and others not effective

Amitriptyline

Clomipramine (Anafranil)

Desipramine (Norpramin)

Doxepin

Imipramine (Tofranil)

Nortrytyline (Pamelor)

SE: constipation, dry mouth, fatigue, low BP, irregular heart rate and seizures

Tetracyclic Antidepressant: maprotiline

Atypical Antidepressants

Dopamine Reuptake Inhibitor (DRI): blocks dopamine transporter, used in ADHD, smoking
cessation, weight loss for morbid obesity, SAD

Bupropion (Wellbutrin)

SE: increase BP, nausea, vomiting, dry mouth, sweating, sore joints, sore throat, diarrhea, dizziness
 5-HT2 Receptor Antagonists

Nefazadone

Trazadone

SE: dizziness, drowsiness, constipation, blurred vision

5-HT3 Receptor Antagonists

Vortioxetine (Brintellix)

MAOI

MAOIs: breakdown of norepinephrine, dopamine and serotonin.

isocarboxazid (Marplan)

phenelzine (Nardil)

selegiline (Emsam)

tranylcypromine (Parnate)

SE: similar to other antidepressants

Contraindications: hypertensive crisis and foods that contain tyramine, St John’s Wort, OTC with
dextromethorphan, herbs containing Rhodiola

MAOI diet: no aged cheeses, deli meats, liver, fermented products, like soy sauce chocolate, caffeine,
over ripe and dried fruit, bananas, alcohol

Bipolar Affective Disorder

Manic / Depression cycles

The Mood Spectrum

Bipolar Affective Disorder

Manic

Phase

‘Normality’

Depressed

phase

Symptoms of Mania

❑ Euphoria
 ❑ Very outgoing, intrusiveness

❑ Manipulative, and controlling if the relationship is unsatisfactory to them

❑ May be abusive to significant others

❑ No need for sleep, increase in nocturnal activity

❑ Pressure of speech

❑ Delusions of Grandeur, Flight of Ideas

❑ Hyperactivity

❑ Gaudy dress and makeup

Symptoms of Mania Continued

❑ Exaggerated self-esteem

❑ Poor judgement

❑ Psychotic symptoms (severe cases)

❑ Spending sprees (not to cheer oneself up)

❑ Increased sexual drive

❑ Abuse of substances (e.g. cocaine, alcohol)

❑ Provocative / aggressive behavior

❑ Denial that anything is wrong (“I feel Grrrreat!”)

Bipolar Affective Disorder (BAD)

Mood disorder fluctuated between expansive, elevated mood state and depression

highs (mania) or lows (depression)

Bipolar I :cycles of acute mania with or without depression

Bipolar II: cycles of hypomania with major depression

Bipolar III: Antidepressant Induced

Rapid-cycling – at least 4+ episodes per year of depression or mania/hypomania

Signs and Symptoms of Depression & Mania

Treatment Modalities for Bipolar Affective Disorder

❑ Mood stabilizers

▪ Lithium
 ❑ Antipsychotic medications

▪ Haldol

❑ Anti-anxiety medications

▪ Valium

❑ Antidepressants

▪ Zoloft and Paxil

❑ Electroconvulsive therapy (ECT)

Other Treatment Modalities

❑ Psychoeducation

❑ Psychotherapy

▪ individual

▪ group

❑ Vocational Counseling

❑ Case management/community mental health workers

Mood Stabilizers Commonly Used

❑ Lithium: affects the flow of Na in the body, impacting excitation or mania

❑ Side Effects: extreme thirst, increase in urination, weakness, fever, lightheadedness, dizziness,
tremors, itchy skin

❑ Contraindications: heart disease, kidney disease, hyponatremia, pregnancy, Flagyl, ACE

Inhibitors, diuretics

❑ Routine blood tests for therapeutic levels

ACE = angiotensin-converting enzyme

Mood Stabilizers Commonly Used

❑ Valproic acid, divalproex (Depakote): anti convulsant

▪ SE: nausea, vomiting, headache, dizziness, weakness, tremors,

swelling in hands and feet, weight gain

▪ Considerations: liver damage

❑ Carbamazepine (Tegretol)

❑ Lamotrigine (Lactimal)
 ❑ Topiramate (Topamax)

❑ Ca+ Channel Blockers

Treating Psychosis in Bipolar

❑ Zyprexa

❑ Seroquel

❑ Risperidone (Risperidal)

❑ Ariprazole (Ambilify)

❑ Clozapine (Clozaril)

Anxiety Disorders

❑ Across the life span

❑ Different Types - e.g. Generalized, Panic, Obsessive Compulsive (overlap Post Traumatic Stress
Disorder

❑ 12% of population experiences anxiety in their lifetime

❑ Women diagnosed more often than men

❑ 5% of Ontarians will have agoraphobia sometime in their lives

❑ Most common (27% of cases) among 15 - 24 year olds

❑ People who have history of physical or sexual abuse in childhood much more likely to have an
anxiety disorder

❑ The highest rates of hospitalization for anxiety are among those aged 65 years and over.

Anxiety is..

❑ Normal and experienced by everyone

❑ An emotion without a specific cause – Not just fear which has a specific identifiable source or
object

❑ Necessary for survival and adaptation

❑ Not harmful or dangerous and typically short lived

❑ Is a problem when impairs activities of daily living

❑ Identified in children, adults, and the elderly

Levels of Anxiety (Peplau, 1963)

Mild Anxiety
 ↑ r/t tension of everyday living

↑ perceptiveness, motivates learning, growth, creativity

Moderate Anxiety

↑ focus on immediate concerns

↓perceptual field

Severe Anxiety

↓ focus on relieving anxiety

↓ perceptual field

Levels of Anxiety (Peplau, 1963, cont’d)

Panic

awe, dread, terror

involves disorganization of personality

↓ motor activity, ↓ ability to relate

↑thought distortions, ↑ distorted perceptions

incompatible with life ‘feeling like dying

Symptoms of Anxiety

❑ Cognitive

❑ Physical

▪ Heart palpitations, increased heart rate

▪ Shallow breathing

▪ Trembling or shaking

▪ Sweating, dizziness, lightheadedness

▪ Muscle tension, shortness of breath

▪ nausea

❑ Behavioural

Anxiety Disorders in Children and Adolescents

❑ 10% of children and adolescents

❑ Genearlized anxiety disorder (GAD) separation, social anxiety

 ❑ Some features:

▪ Fearful or cautious, lacks self-confidence

▪ Unrealistic worries

▪ Shy, socially withdrawn

▪ Physical complaints – headaches, stomachaches, and nausea; poor/picky eaters

▪ Nightmares, difficulty falling asleep or sleeping through the night

Diagnosing Anxiety Disorders in Children and Adolescents

❑ Physical symptoms of anxiety can be caused by several medial conditions, medications

❑ Medical factors must be ruled out before diagnosis

Question: What foods may cause anxiety?

Anxiety in the Elderly

❑ Comorbidity with depression, physical disorder and/or cognitive dysfunction

❑ About 10% of elderly experience anxiety; prevalent in the elderly who live in retirement/assisted
living facilities-

❑ The most common anxiety disorders in this age group are specific phobia, agoraphobia, GAD
and social anxiety disorder.

❑ Symptoms include primary concern about a physical complaints

Generalized Anxiety Disorder (GAD)

❑ heightened anxiety over extended period of time

❑ excessive anxiety and worry most days, for at least 6 months

❑ worry difficult to control and causes distress or impairment of social or occupational functioning

❑ Other Symptoms:

▪ restlessness, “on edge”, irritability

▪ fatigue / difficulty concentrating

▪ muscle tension

▪ sleep disturbance

Panic Disorder: Recurrent Panic Attacks

Panic attack - discrete period of intense fear or discomfort which develops abruptly and peaks within 10
minutes. Symptoms include:

▪ pounding heart palpitations

▪ sweating

▪ trembling or shaking

▪ sensation of shortness of breath or smothering

▪ choking feeling

▪ chest pain or discomfort

▪ nausea, abdominal pain

▪ dizziness, lightheaded or unsteady feeling

▪ feelings of unreality

▪ fear of losing control

▪ fear of dying

▪ numbness, tingling

▪ chills or hot flushes

Panic Disorder Prognosis

❑ take symptoms seriously

❑ include lifestyle advice

❑ severe cases - CBT + medication

❑ start low, go slow

❑ improvement within 6-8 weeks

❑ no response 12 weeks-re-evaluate treatment? diagnosis? Challenges?

Obsessive - Compulsive Disorder (OCD)

❑ Repeated obsessions or compulsions that are time consuming; cause marked impairment or
significant distress

❑ No known origin

❑ Not common, only 1-2% of population will experience

❑ Distressing intrusive thoughts, images or impulses that appear to practically consume the mind
so completely that much of the day can be spent trying to suppress or neutralize the obsessive
thoughts and its associated anxiety.

OCD Symptoms

❑ Ritualistic behaviours include:

▪ Excessive hand washing

 ▪ Hoarding

▪ Checking

▪ Reciting phrases

❑ May do a combination of rituals to suppress anxiety

❑ Begins in early adulthood/ late adolescence

❑ Significant impairment in family/intimate relationships

❑ Example http://www.youtube.com/watch?v=44DCWslbsNM

OCD Treatment Options

❑ Pharmacotherapy with antidepressants and clomipramine

❑ CBT and exposure therapy

Nursing Interventions for Anxiety Disorders

❑ Therapeutic Relationship

▪ Insight

▪ Coping Strategies

▪ Health Teaching

▪ Relaxation Techniques

▪ Relaxation Training

▪ Meditation

▪ Therapeutic Touch, and related techniques

▪ yoga

❑ Safety

❑ Environmental Management

❑ Encouraging Activity

❑ Support Medical Plan of Care

Post-traumatic Stress Disorder (PTSD)

❑ Trauma and Stress Related Disorder vs. Anxiety Disorder

❑ Characterized by flashbacks

❑ Avoidance of situations similar to original trauma

❑ Numbing of general responsiveness

❑ Symptom patterns must:

▪ persist for more that one month

▪ cause significant distress

▪ impairment of normal functioning

Symptoms of PTSD

❑ nightmares, disturbing memories

❑ avoidance of activities, places or people that are reminders

❑ avoidance of friends and family

❑ lost interest in activities

❑ lost ability to feel pleasure

❑ constantly worrying, difficulty concentrating

❑ sleep problems

❑ fearing harm

❑ sudden attacks of dizziness, fast heartbeat or shortness of breath

❑ fears of dying

PTSD Etiology

❑ Can occur at any age

▪ Children may respond by behaviorally, may re-enact the trauma in play, often
cope by forgetting

▪ Adults often show signs of depression, anxiety, addiction, relationship problems,

vocational difficulties, physical illness, etc

❑ “Trauma” is defined by the person

❑ Episodes “triggered” by

▪ Sensory stimulants replicating trauma

▪ Anniversary dates

▪ Milestones and life-course events

▪ other

Assessment
❑ Is there a traumatic event that the person experienced?

❑ Did it occur more than 30 days ago?

❑ Is the person having trouble resolving or coping with the event?

❑ Is professional nursing care required, and is it acceptable to the client to receive nursing care?

❑ What does this individual require of a nurse?

Interventions

❑ Intervention plan developed collaboratively with the client

❑ Desensitizing to memories

▪ Abreaction, cognitive restructuring (thought stopping and thought substitution),

psychotherapy

❑ Reduce anxiety

▪ Relaxation training, Reiki, Therapeutic Touch, Healing Touch, Exercise,

Biofeedback, yoga

Interventions (Cont’d)

❑ Support and develop coping strategies

▪ Improve resilience to triggers: e.g. nutrition, exercise, relationships, sleep, meaningful

activities

▪ Plan around anniversary dates and events

▪ Education about trauma, its effects on health and usual treatments

❑ Involve family and significant others if this is acceptable to the client and only if it will be helpful

❑ Health promotion as necessary

❑ Children benefit from play therapy, therapeutic story telling and art

Medications Used to Treat Anxiety

❑ Benzodiazepines: short acting

▪ Lorazepam (Ativan)

▪ Clonazepam (Klonopin)

▪ Diazepam (Valium)

▪ Alprazolam (Xanax)

❑ Chlordiazepoxide (Librium)

❑ SE: dizziness, memory issues and dependence Caution: respiratory depression

 ❑ busipirone (BuSpar)

HH/NURS 3524 6.0:

Health & Healing: Client Centered Care of Individuals and Families in Child and Mental Health
Settings

Course Director (Mental Health)

Ann Pottinger RN,MN

Assistant Professor, Teaching Stream

pann@yorku.ca

Objectives

At the end of this lecture students will:

❑ Identify symptoms of depression and pharmacological treatments (Week 2 cont’d)

❑ Discuss issues and treatment options

▪ Bipolar Affective Disorder

▪ Anxiety Disorders

▪ Dementia

❑ Discuss nursing care to individuals with anorexia nervosa, bulimia nervosa, and binge
eating disorders

❑ Discuss options for children’ mental health issues

▪ Common childhood stressors and neurocognitive disorders

❑ Distinguish the clinical features, onset and course of neurocognitive disorders – delirium
and dementia Part 2

❑ Eating Disorders

Anorexia Nervosa

❑ Starts in early adolescence up to adulthood

❑ Caused by stressful life transitions, likely anxiety

❑ Chronic disease, may take long periods for recovery

❑ Many have another psychiatric diagnosis, often mood disorders

❑ DSM V criteria: BMI <16.5

: food restrictions, starvation

: binge eating with use of diuretics, laxatives, enemas and vomiting

Treatment

❑ Refeeding: target malnutrition and dehydration issues

❑ Therapy for body dysmorphia

❑ SSRIs with regaining of weight

Bulimia Nervosa

❑ Early adolescence, adulthood onset

❑ Binging and purging in secret; abuse of laxatives, diuretics, or fasting and overexercising

❑ Many rules and preoccupation with food; anxiety, mood disorder

❑ Leads to guilt and self loathing

Treatment

❑ Intake diary

❑ Manage electrolyte imbalance

❑ Cognitive behaviour therapy

❑ Fluoxteine (Prozac) effective

Binge Eating D/O

❑ Ingesting large amounts of food, short period of time, loss of control, distress and feelings of
guilt and depression after

❑ binge eating once a week X 3 months

❑ occurs after a period of restraint, hunger or feeling low

❑ Type 2 Diabetic, mood or anxiety disorder, substance use

❑ Starts in adolescence

❑ See Table 25.13

Treatment

❑ Psychotherapy

❑ Nutrition counseling

❑ Topirmate: antiepileptic medication, controls binge eating

❑ Orlistat: GI lipase, breaks down triglycerides to prevent breaking down into free fatty acids

❑ Fluoxetine
 Dementia

Not a disease

Umbrella term to describe a syndrome of progressive decline in multiple areas of cognitive

function, sufficient to interfere with social or occupational performance

Not due to depression or delirium

Dementia affects 8% of all individuals over the age of 65

More than a quarter of a million older Canadians have this condition

By 2031, this number will rise to more than 750,000

Cognitive Functions Affected

❑ Memory (usually)

❑ Aphasia (loss of language)

❑ Apraxia (loss of purposeful movement)

❑ Agnosia (loss of recognition)

❑ Executive function (loss of ability to plan, organize, sequence, and abstract)

Deteriorations Over Time

Deterioration and changes in:

❑ mood

❑ cognitive function

❑ functional function

❑ behavioural problems

❑ motricity motor function (stiffness)

Dementia Risk Factors

❑ Lower education

❑ Advanced age

❑ Family history

❑ Alcohol abuse

❑ Previous head injury

❑ Genes and chromosomes: Two copies of the ApoE ε4 allele (gene) and mutations on
chromosome 1, 14, and 21
 Establishing Causes Dementia

❑ Can result from diseases that affect the neurons of the cortex or subcortex of the brain. The
symptoms vary according to the areas of the brain that are most affected

❑ More than 70 conditions cause dementia in older adults (Cohen et al., 1993)

❑ TB, AIDS, alcohol toxicity, neurosyphilis, infections, metabolic disorders, nutritional imbalance

❑ Many of these conditions result in dementia-like symptoms, which can be treatable, arrestable,
or even reversible

Dementia Mnemonic

Which letters in this mnemonic represent treatable or reversible causes?

D = Degenerative

E = Emotional

M = Metabolic and endocrine

E = Eyes and ears

N = Nutritional

= Normal pressure hydrocephalus

T = Trauma and tumor

= Toxic

I = Infection

A = Arteriosclerotic and vascular

Cognitive Impairment and Dementia

❑ Mild Cognitive Impairment

❑ Alzheimer's Disease

❑ Vascular Dementia

❑ Lewy Body Dementia

❑ Frontotemporal Dementia

❑ Parkinson’s Disease

Alzheimer's Disease

❑ 50% of all dementia cases are Alzheimer’s

❑ Disease process begins slowly

 ❑ Memory loss (a decrease of 2-3 points on MMSE annually)

❑ Language problems (aphasia)

❑ Problems with identifying and recognizing things (agnosia)

❑ Problems with activities and coordination (apraxia)

❑ Problems with complicated functions (executive functioning)

Nursing Implications for Dementia

❑ Supporting families along with the client with cognitive impairment disorders

❑ Difficulty with interacting with others

❑ Possibility for safety issues with caregivers, why?

❑ How could you make a dementia patient more comfortable?

Pharmacotherapy

Cholinestrerase inhibitors

❑ donepezil (Aricept)

❑ galantamine (Razadyne)

❑ rivastigimine (Exelon)

❑ SE: nausea, vomiting, diarrhea, weight loss

Is it Delirium?

❑ involves a disturbance of consciousness associated with impaired alertness and attention

❑ clinically manifested as lethargy or diminished arousability, with or without periods of agitation

Mnemonic for Delirium I Watch Death

❑ I WATCH DEATH:

I= Infections D = Deficiencies

W= Withdrawal E = Endocrine

A= Acute metabolic A = Acute vascular

T= Trauma T = Toxins or drugs

C = CNS Pathology H = Heavy Metals

H= Hypoxia

❑ Do not watch death – Screening CAM - Confusion Assessment Method

 Children’s Mental Health
Mood and Nerurobiological Disorders

ADD, ADHD Symptoms

Core symptoms (DSM-V) are inattention, hyperactivity, and impulsivity

❑ Believed to interfere with emotional and psychological development

❑ Interferes with academic, family, and social functioning and most obvious in the
classroom

ADD/ADHD Prevalence

❑ ADHD 5-9 % of all school aged children

❑ Male: Female 4:1- believed that girls are under diagnosed

❑ Disorder present by the age of 7, and in 2 settings other than school, at home or outside
recreational activities

❑ Etiology – genetic, cognitive, arousal

Treatment/Interventions of ADD, ADHD

❑ Medical – Common pharmacological treatments (use of Ritalin, Dexedrine,); Side effects –

nervousness, insomnia, hypertension, anorexia, weight loss, and suppression of growth

❑ Nursing – reduce stimuli, consistent and predictable routines

❑ Family – firm and reasonable limits, stable and predictable environment

❑ Educational – modify the child’s classroom environment to improve learning

❑ Social Skills Training – deal with interpersonal conflict and social cues

Implications for Nursing Care for Children with ADD, ADHD and LD

Health teaching must be very carefully evaluated

Use multiple methods of teaching

Patience

Family education and support

Maintaining a calm demeanor

Autism Spectrum Disorder and Pervasive Developmental Delay (PDD)

❑ difficulty relating to others

❑ problems with speech and non-verbal communication

 ❑ limited and repetitive interests and behaviour, such as hand flapping and rocking.

❑ Autism is four times more frequent in boys than in girls.

❑ Characteristics associated with autism tend to run in families.

❑ It can occur in people of all ethnic, social, education and income groups.

❑ It affects about 1 in 150 children.

❑ According to Autism Ontario, there are about 70,000 people with autism in Ontario.

Autism

❑ Respond to information in different ways

❑ Can start as early at 18 months of age

❑ Stop meeting milestones and stop communicating with parents, siblings; loss of language

❑ Characteristics include insisting on sameness, resists change

❑ Laughs, cries or shows distress without any reason

❑ Little or no eye contact

❑ Prefers to be alone

❑ Doesn’t respond to cues

❑ Ritualistic

Available Treatment

Applied Behaviour Analysis (ABA)

❑ behaviour management/emotional regulation

❑ communication

❑ social /interpersonal

❑ daily living

❑ build skills and reinforce positive behaviour, help the young children and adolescents be more
independent and manage at school

❑ School Support Programs

❑ Work with a resource teacher in the school system

❑ Respite and Camps

Sources
Austin, Kunyk, Peternelj-Taylor & Boyd (2019) Psychiatric & Mental Health Nursing for Canadian
Practice (Course Text) Chapters

Autism, Ministry of Children and Youth, retrieved from http://www.children.gov.on.ca

Autism Spectrum Disorder for Families, retrieved from:

http://www.erinoakkids.ca/Resources/Autism

Cognitive Disorders and Dementia retrieved from: http://www.apa.org

Memory and Aging retrieved from http://www.baycrest.org